Provider Demographics
NPI:1073511226
Name:RENBAUM, LAURA CHAPMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CHAPMAN
Last Name:RENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10784 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3646
Mailing Address - Country:US
Mailing Address - Phone:410-964-0425
Mailing Address - Fax:410-964-0515
Practice Address - Street 1:10784 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3646
Practice Address - Country:US
Practice Address - Phone:410-964-0425
Practice Address - Fax:410-964-0515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00464092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD436SMedicare ID - Type Unspecified
MDF21081Medicare UPIN